Provider Demographics
NPI:1871082784
Name:SARACZEWSKI, KRZYSZTOF (MD)
Entity type:Individual
Prefix:
First Name:KRZYSZTOF
Middle Name:
Last Name:SARACZEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 GARFIELD AVE APT B
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-3828
Mailing Address - Country:US
Mailing Address - Phone:856-701-8556
Mailing Address - Fax:
Practice Address - Street 1:220 DUNCAN DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31409-5102
Practice Address - Country:US
Practice Address - Phone:912-435-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71894-20390200000X
WI7189420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI71894-20OtherLICENSE